Information Collection

DVS Proposal

IC 278253 under ICR 202512-0920-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25-0036 DVS Proposal	Form and Instruction
Form 0920-25-0036 Data Request Application DVS Proposal	Form and Instruction
0920-25-0036 Data Request Application Attachment C - NCHS Restricted Vital Statistics Data Request Application Form.pdf	Form and Instruction
0920-25-0036 Data Request Application Attachment C - NCHS Restricted Vital Statistics Data Request Application Form.pdf	Form and Instruction

IC Title:

DVS Proposal

Agency IC Tracking Number:

0920-25-0036

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-25-0036				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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